Provider Demographics
NPI:1336766864
Name:IAKOVAKIS, LACY
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:IAKOVAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-2643
Mailing Address - Country:US
Mailing Address - Phone:512-924-9904
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2643
Practice Address - Country:US
Practice Address - Phone:918-285-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker